House of Lords Reform

Debate between Graham Stringer and Justin Madders

Tuesday 10th January 2023 Westminster Hall

[Justin Madders]

That is an interesting suggestion. I would suggest that lords in that position should do the honourable thing and resign. We have spoken about the Government wanting to have minimum service levels; indeed, they want to sack nurses and teachers who do not keep to those. Perhaps they should apply the same standards to Members of the Lords.

I am certainly not claiming that there are no valuable elements of the current House of Lords. As we have heard, there are many extremely talented Members who demonstrate high levels of integrity, expertise and independence. However, we make a huge mistake in assuming that the second Chamber is naturally imbued with those characteristics because of the way that Members are appointed. As we have heard, there is a growing tendency for those with the biggest cheque books to be offered a seat at the table. That is not democracy; that is not the way a modern country should operate. I see no reason why those who have a place because of their skills, experience or abilities would not have a good chance of continuing to serve if they put themselves forward for election by the public. Ultimately, for all the positive qualities that those particular Members show, their contribution is fatally undermined by the lack of democratic legitimacy.

We essentially say to the public, “We trust you to decide on our future relationship with Europe. We trust you to elect Members of Parliament, councillors, police and crime commissioners, and Mayors. But we do not think we can trust you to elect the upper Chamber of Parliament.” I have no truck—we have already picked up on this—with those who are recent converts to the merits of the House of Lords just because, on a particular occasion, it voted in a particular way that suited their political views. That does not negate the overall democratic deficit that, in its current form, it represents. Let us not allow the day-to-day decisions, and the painfully slow incremental process that we have seen, to cloud the bigger picture: the House of Lords belongs to a bygone era of privilege, establishment and a closed political world, when we are, I hope, becoming a more open society.

[Graham Stringer (Blackley and Broughton) (Lab)]

The hon. Member for Glasgow North (Patrick Grady) made a fundamental point: if we reform the House of Lords, we effectively reform the House of Commons. My hon. Friend is suggesting direct democracy for the House of Lords. Does he agree that that would necessarily diminish the powers of the House of Commons? It would put another House in opposition to our House, which would be a bad thing.

[Justin Madders]

That is not necessarily the case, and that is not where the argument need take us. That kind of argument is often put forward by people who want to stifle change and reform.

I cannot believe that anyone would think that the current arrangements are satisfactory. We have, in effect, a halfway house between the medieval institution the Lords once was and the modern democracy that we, or certainly I, hope to see. When the number of hereditary peers was reduced in 1999, Baroness Jay described the Lords as a “transitional House”. It is clearly an anomaly that we have certain people entering there by different routes, and it is time that that was ended.

[Justin Madders]

That is 92 too many, in my opinion. I do not believe that having a place in our legislature by reason of birth has any place in our modern democracy.

As has been picked up on already, the recent report from former Prime Minister Gordon Brown sets out the case for reform very well; it contains serious proposals for what a modern, democratic second Chamber could look like, which could be implemented without us necessarily having to change the way we in this House work. Some of the big messages in that report about the loss of trust in our democratic institutions are ones that we should all be concerned about. The fact that more than 50% of adults believe it does not matter who they vote for and that nothing will change, and that more than 60% of people believe that Britain has a ruling class that will always rule the country, should ring huge alarm bells for single one of us who cares about democracy in this country.

[Graham Stringer]

My hon. Friend is being generous in giving way. I would like to pursue the point. If a second Chamber were elected after the House of Commons had been elected, how would conflict between the two Houses be resolved if they had two contrary mandates? I agree that the current House of Lords is not justifiable, and I believe in its abolition, but I do not think we should set up an alternative democratic base to the House of Commons.

[Justin Madders]

I refer my hon. Friend to the recommendations set out in the Brown report, which outline the limitations on a second Chamber’s ability to reject legislation. The suggestion is for it to have a defined constitutional role and this will cover when it is able to reject issues. Those are matters for further discussion, but nations around the world manage to have democratically elected second Chambers without creating chaos. I believe that is something we should aim for.

Coming back to the figures, we should take very seriously the fact that so many people have so little faith and trust in us representing them. Democracy is fragile and should not be taken for granted. We ignore those findings at our peril. We have to make our politics more open and accountable to the people we serve. An appointed body cannot have a future in that respect.

I will finish on this point. There are always pressing priorities, but we need to look at the bigger picture and at how the world is radically different from just a decade ago. We cannot allow our institutions to remain static forever. We must listen to what the public are telling us.

Ealing Hospital

Debate between Graham Stringer and Justin Madders

Tuesday 3rd May 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this extremely important debate and on the eloquent way he introduced it. He is widely known in this place for championing issues on behalf of his constituents; his contribution today will only further enhance that reputation. He presented a comprehensive picture of his constituency, rightly highlighting the scandal of health inequalities there and his concern about the implications for patient safety of the Government’s proposals. He cited staggering figures for the growth in elderly population in his area—not unique, but by no means to be ignored. He expressed his concern that the most vulnerable and those whose children have long-term conditions will have to travel further to access services, with possible negative implications for their economic situation. It is clear from what he said that he and his constituents have lost confidence in the process.

I draw attention to the contribution from my hon. Friend the Member for Ealing Central and Acton (Dr Huq). She is new to this place but is fast gaining a reputation as a Member who assiduously represents her constituents. She described the Government’s response as intransigent. If that is her experience, I am sure it is no reflection of the effort she has put in. She compared Ealing to the city of Leeds, and it is unthinkable that a city the size of Leeds would not have such fundamental health services as those being discussed today. She described what has been presented to us over the past few years as a bad deal all round. As an academic, she has based her comments on the evidence she has seen, not on opinion. She and my hon. Friend the Member for Ealing, Southall both expressed concern that Ealing hospital is on the way out. Those were not careless comments thrown about for political gain but genuine anxieties born out of what they see and hear.

My hon. Friend the Member for Hammersmith (Andy Slaughter) correctly said that the sooner the business plan for further implementation is available, the better. He identified the lack of information as a factor that has made the situation far more difficult than it could have been. As he says, where there is a vacuum, something will fill it. In this case, the vacuum has been filled by rumours—rumours so strong that two of my hon. Friends have felt compelled to raise them here today. He said that transparency will help; I certainly agree with that. I also agree that our concerns are no reflection on the hard work and valuable contribution that our NHS staff make each and every day.

More than 100,000 people have now signed the petition to express their concern about service downgrades and what they see as a real threat to the future of Ealing hospital. Their concerns relate to the “Shaping a healthier future” programme, which was launched in 2011 by a group of what were then 10 primary care trusts,

“to reshape hospital and out of hospital health and care services in North West London.”

Following the abolition of primary care trusts, the North West London Collaboration of Clinical Commissioning Groups has led the programme. It has proposed a number of extremely significant changes, including the downgrading of accident and emergency services at a number of hospitals.

In 2013, Ealing Council’s health overview and scrutiny committee referred the programme to the Secretary of State, who concluded that changes to NHS services in north-west London should proceed. In a statement, the Secretary of State said that five of the nine hospitals—Hillingdon, Northwick Park, West Middlesex, Chelsea and Westminster, and St Mary’s—would provide comprehensive, seven-day-a-week acute emergency care. He also stated that A&E departments at Ealing and Charing Cross hospitals would remain open, although with what—as my hon. Friend the Member for Ealing Central and Acton pointed out—he euphemistically called changes to the “shape or size” of services. Those changes have probably not turned out as people hoped. Changes were recommended to replace the A&E services of Hammersmith and Central Middlesex hospitals with urgent care centres, which were subsequently implemented in September 2014.

In 2013, it was decided that maternity services would be consolidated on to six hospital sites and maternity deliveries at Ealing hospital would cease. We have heard from my hon. Friends how significant that has been for their communities. The maternity unit at Ealing hospital was closed in July 2015. It has now been recommended that in-patient paediatric services should also be moved to maintain appropriate staffing levels. These changes have, understandably, caused great public concern, which in 2014 led to Brent, Ealing, Hounslow, and Hammersmith and Fulham Councils establishing an independent commission under Michael Mansfield QC to review the impact of the changes to the north-west London health economy and to assess the impact of planned changes.

On 2 December 2015, the commission published its final report, which was extremely critical of the “Shaping a healthier future” programme, finding that inadequate consultation had been undertaken and that departments had been shut without providing adequate alternative healthcare. Its recommendations included halting the SHF programme and that local authorities should consider a legal challenge. The Government’s response states that they are

“clear that reconfiguration of front line health services is a matter for the local NHS.”

It is clear from answers to parliamentary questions and a Westminster Hall debate on 24 March that both the CCGs and the Government do not accept the review’s findings.

The principle that decisions should be made locally by clinicians is sound, but there seems to be an issue about accountability in this case, as there is a clear feeling among the public and local politicians that their concerns are simply not being heard. Those who gave evidence to the commission were not fly-by-nights. Many were working on the front line of the services under discussion. Indeed, they are the local clinicians the Government say should be making the decisions. What recourse do clinicians, the public and patients have if they disagree so fundamentally with what is being done as we have seen here?

The most successful service reconfigurations are those where consultation is most effectively carried out and where support from clinicians at all levels, local politicians and, of course, members of the public is secured. It is no coincidence that when public concern is at its present level in Ealing and the surrounding communities, we tend not to see successful changes in provision.

Such was the frustration and concern about the changes that four local councils thought it necessary to use local taxpayers’ money to commission an independent report. As my hon. Friend the Member for Hammersmith said, the local authorities involved have behaved responsibly in commissioning this report. I do not believe there is any suggestion that they have behaved irresponsibly, so surely the Minister must acknowledge that taking this extraordinary step means that something must have happened that deserves further examination.

I turn to some of the recommendations in the independent report. Serious concerns have been raised about the consultation in 2012. There has been no significant further consultation since. Given that we are now four years on from that point and that the scheme has undergone considerable changes, as has the demographic make-up of the communities, it seems reasonable to consider a further period of consultation.

Concern was also expressed in the Mansfield commission’s report and here today about transparency, particularly in the business case on which the SHF scheme is based. I would welcome the Minister’s observations on both points, and if, like me, she is not satisfied that there has been sufficient public involvement, will she step in and ensure that that takes place before further downgrades or closures and that it is genuine consultation predicated on release of the full business case? Genuine consultation cannot take place if vital information is withheld. Transparency is the key to meaningful engagement.

The commission was asked to look at deteriorating standards in three local NHS trusts that were consistently failing to meet key targets, including that 95% of patients attending A&E must be seen, treated and admitted or discharged within four hours. The Minister will be aware that after six years of a Conservative Government, February’s figures are the worst on record for A&E waiting times. The most recent figures confirm that all three NHS trusts covering this area are failing to meet their targets.

In major A&E units, London North West Healthcare NHS Trust saw just 76% of patients within four hours and Imperial College Healthcare NHS Trust saw 69.1%. Does the Minister agree with the commission that the closures of Hammersmith and Central Middlesex A&E departments are responsible for these appalling figures, or is the Government’s overall record to blame?

Finally, the other key principle to which all service reconfigurations should adhere is that they should be based on clinical rather than financial need. They must represent what is in the best interests of the patients who access the services and not simply be a tool to balance budgets at any cost. In this case, because the Government have fundamentally lost control of NHS finances with 75% of trusts now in deficit, local people are understandably asking whether the serious financial hardship that the trusts face is forcing the CCGs to consider changes that they otherwise would not. Can the Minister assure us that no decision will be made in this case or any other on the basis of finance alone and that the interests of patients will remain the central focus at all times? It is clear that public confidence has been lost in this case, and it is simply not good enough for the Government to wash their hands of it. We urgently need an acknowledgement of those concerns and concrete plans to address them.

[Graham Stringer (in the Chair)]

To clarify, the debate, although it started early, will finish at 2.30 pm. Could the Minister leave a minute or two at the end for the proposer?